Antenatal betamethasone and the risk of neonatal hypoglycemia: it's all about timing
- PDF / 837,861 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 71 Downloads / 140 Views
MATERNAL-FETAL MEDICINE
Antenatal betamethasone and the risk of neonatal hypoglycemia: it’s all about timing Yaniv Zipori1 · Ragda Zidan1 · Roy Lauterbach1 · Arin Hagag1 · Yuval Ginsberg1 · Ido Solt1,2 · Zeev Weiner1,2 · Amir Kugelman2,3 · Ron Beloosesky1,2 Received: 3 August 2020 / Accepted: 31 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Our objective was to evaluate whether there is a relationship between the “time during the day” of maternal betamethasone administration between 24 and 34 weeks’ gestation and the risk for neonatal hypoglycemia. Material and methods A retrospective study included cases between 2008 and 2018. Eligible cases were pregnant women with singleton pregnancies who received a single course of betamethasone between 24 and 34 weeks’ gestation. Each woman was allocated into one of four pre-defined groups based on the time when intramuscular betamethasone was administered. Group 1 (23:00–04:59) represents the lowest daily natural corticosteroids’ activity, group 2 (05:00–10:59) represents the peak daily natural corticosteroids’ activity, whereas group 3 (11:00–16:59) and group 4 (17:00–22:59) present an intermediate natural state of steady corticosteroids’ secretion and activity. The primary outcome of the study was the incidence of neonatal hypoglycemia (glucose level of less than 40 mg/dL). Results We have identified 868 women who received a single complete course of betamethasone, of which 353 women (40.7%) had a steroid treatment latency to delivery up to 14 days. The incidence of neonatal hypoglycemia was significantly higher in group 2 (39.5%, 30/76, p = 0.0063), compared to group 1, who had the lowest incidence of neonatal hypoglycemia (16.9%, 12/71), and to group 3 and group 4. Conclusions The “time during the day” when betamethasone administered is important when considering the risk for neonatal hypoglycemia. The risk was significantly higher when betamethasone was administered during the peak time and significantly lower when administered at the nadir time of maternal endogenous corticosteroid activity. Keywords Corticosteroids · Antenatal betamethasone · Neonatal hypoglycemia · Time during the day · Pregnancy
Introduction In humans, under normal conditions, the secretion of corticosteroids is under the regulation of the hypothalamic–pituitary–adrenal (HPA) axis, and characterized by 24-h circadian oscillations, with the lowest corticosteroid levels around midnight and an acrophasic peak around 08:00 AM [1–4]. During pregnancy, placental 11β-hydroxysteroid * Yaniv Zipori [email protected] 1
Department of Obstetrics and Gynecology, Rambam Health Care Campus, 3109601 Haifa, Israel
2
Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
3
Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
dehydrogenase type 2 (HSD11B2) limits fetal exposure to maternal corticosteroids from early gestation [5]. Exogenous synthetic corticosteroids, however, either betame
Data Loading...
